Seven-year-old Nader Parman II was playing baseball in his own front yard in Marietta, Ga., when a baseball struck him in the chest at just the wrong moment, killing him.
The ball hit Nader in the area right above his heart, at exactly the right millisecond to cause a fatal abnormal heart rhythm and trigger cardiac arrest. The injury is rare, but not unheard of. Doctors see as many as two dozen cases like Nader's each year, in which the victim has a healthy heart.
The batted ball caused Nader to have what's medically known as commotio cordis — a syndrome that results from a blunt impact to the chest which leads to cardiac arrest.
Some commotio cordis deaths have been caused by a blow from a hollow plastic bat, but the most common cause is from being struck by a ball or puck during organized sports.
Nader, a first-grader, had been playing baseball with a 15-year-old neighbor boy who lives on the street. The boy told police that he had intended to hit a pop fly for the younger boy, but instead he accidentally ended up hitting a line drive that hit Nader in the chest. The boy's father, Nader Parman, dashed out of the door right after his son was injured.
"He ran outside as quickly as he could, picked up my son, brought him inside the house and immediately started administering CPR, calling 911," Sherri Parman told Good Morning America. But it wasn't enough.
Heart’s Rhythm Thrown Off
When a child collapses from commotio cordis, CPR techniques are of little use, experts say. A portable defibrillator, like the ones used to resuscitate adult heart attack victims, might have saved Nader if it was used within the first three minutes after it happened. But without it, even immediate first aid was too late.
"After three to five minutes, if you cannot get the individual back into their regular rhythm, it's unlikely that they'll survive," said Dr. Mark Link, associate professor of medicine at Tufts New England Medical Center in Boston.
A normal heart beats more than 100,000 times a day, Link said. But if a baseball or other hard object strikes just the wrong spot during the 15 milliseconds between beats, the heart can quit beating. Instead it will fibrillate, or quiver, inside the chest.
"The impact has to occur directly over the heart," said Link, who wrote about commotio cordis in an article that appeared in the Journal of the American Medical Association. "It has to occur during a very narrow time segment of the cardiac cycle, which is about one to two percent of the cardiac cycle. It's also important that the energy of impact is correct. It can't be too fast or too slow."
Most Injuries Are Fatal
The vast majority of the commotio cordis victims die. Nearly all of them are male, under the age of 20, which is when the chest wall finishes developing. The most vulnerable are children under the age of 12 whose chest cages are narrow, and who have underdeveloped chest muscles. Experts say that while most chest injuries are associated with football or baseball, they can even occur in the home with objects that are not considered dangerous.
The JAMA study found that bodily contact during shadow boxing, playing with the pet dog, parent-child discipline, gang rituals, intervening in scuffles, and attempts to remedy the hiccups have also caused death.
But, 60 percent of the incidents are caused by baseballs. Most of the other sports-related cases occurred in ice hockey, with other instances reported in connection with football, lacrosse, basketball, cricket, martial arts, boxing, fights, and vehicular accidents
Because of the risk, some baseball players wear special chest protectors beneath their shirts. The JAMA study concludes that the safety of young athletes can be improved by wearing of equipment that can protect the chest wall from blows. Other preventive measures include having young players use soft baseballs, and educating participants and coaches.
Nader's mother says parents should have their children wear protective gear no matter how safe the sport they play may seem.
"You never know when this will happen," she said. "Hug and kiss your children as much as possible."
For those who wish to make contributions in honor of Nader, his family is asking that people send donations to the camp he attended, Camp Jenny, c/o Temple Kol Emeth 1415 Old Canton Rd., Marietta, GA 30068 or the Camp Chai Scholarship Fund, c/o Marcus Jewish Community Center 2509 Post Oak Tritt Rd, Marrietta, GA 30062.